Business Psychology Associates

1. Business Psychology Associates In Partnership With Idaho Department of Health and Welfare Substance Use Disorder (SUD) Bureau Case Management Training Dean Allen, M. Ed. LCPC, LSW, QSUDP Clinical Regional Field Staff

2. Learning Objectives Define Case Management (CM) Understand the Purpose of CM Services Identify CM Qualifications Introduce Models of Case Management Explore the Role of CM Identify Values and Objectives Define Components of CM Review CM Documentation Introduce CM Code of Ethics Define Purpose CM Supervision

3. Definition Case management is a collaborative process that assesses, plans, links, coordinates, monitors, and advocates for options and services required to meet the client's health and human service needs. Serves as the client’s partner, NOT as the client’s: Parent Therapist Supervisor

4. Purpose Keep the client engaged in treatment Improve client outcomes Facilitate access to needed services Maintain the least restrictive level of care required for successful client outcomes (must not duplicate any other state funded services, such as Medicaid)

5. Case Manager Qualifications Basic and Intensive (Recovery Support Services): • SUD Case Managers must meet the following criteria: • Qualified Professional (QP), per IDAPA 16.07.20 (section 745:04) • ISAS or Trainees must have intensive clinical supervision at least one (1) hour per month and a Learning Plan. -or- • Bachelor’s degree in a *human services field from a nationally accredited university or college(with 6 months or 1040 hours of supervised experience working with SUD population) -and- • Case Management Training Certificate-issued by the Department within 6 months of hire. • *Related fields: • Sociology Social Work • Psychology Counseling • Health Ed./Promotion  Alcohol and Drug Studies

6. Case Manager Qualifications Clinical Case Management (SUD Treatment Services) • SUD Clinical Case Managers must meet the following criteria: • Master’s Level Licensed Qualified Professional (QP), per IDAPA 16.07.20 (section 455:03) • Clinical Case Manager must have at least one (1) hour of clinical supervision per month • A Clinical Case Manager may not hold trainee status • Case Management Training Certificate-issued by the Department within 6 months of hire.

7. Case Management Models I. Basic (Brokerage/Generalist) • Brief (less than 6 mo.) • Identify needs • Broker supportive services II. Intensive • Long-term • Resource acquisition • Complex client needs: • criminal justice • co-occurring disorders • pregnant and parenting women III. Clinical • Long-term • Comprehensive • Resource acquisition • Clinical activities: • SUD treatment • and/or psychotherapy)

8. Case management intensive learning plan components 1) Assessments 2) Planning 3) Monitoring 4) Coordinating 5) Linking 6) Advocating

9. Desired Outcomes • The intensity level of case management should be matched with the intensity of the patient needs • Adequate matching of services and referral • Co-Occurring - Quadrant • Support for client as he/she moves through the recovery continuum • CM not static • Right care in the right place for the right length of time • Team Approach • Early intervention • Proactive (Assertive) • CM services planning that reinforces treatment goals • Motivational enhancement Denial/Resistance

10. Co-occurring Disorders by Severity IV More Severe Mental disorder More severe Substance abuse Disorder II More severe Mental disorder Less severe Substance abuse disorder III Less severe Mental disorder More severe Substance abuse Disorder I Less severe Mental disorder Less severe Substance abuse disorder

11. Case Management • OBJECTIVES • Keep the client engaged in treatment • Improve client outcomes • Facilitate access to needed services • Maintain least restrictive level of care • VALUES • Self-determination maximized • Client & family involved in developing plans & outcomes • Individualized & client driven • Client choice • Accessible • Settings & Times convenient to client • Community-based • Holistic • Culturally appropriate • Efficient, effective, and accountable

12. Non-Professional Resume Group Activity Each group will receive poster paper and markers. Brainstorm all of the talents each of you possess Non-work related skills, experience, gifts or assets Think creatively and collaboratively Examples: collectively we speak three languages , can make a great seven course meal You can list individual’s skills or what you could accomplish using all of your skills together (i.e. renovate and redecorate a house Not everyone in the group has to have the skill in order for it to go on the resume. Please document your group’s resume on poster paper; Be prepared to share your resume with the whole group.

13. Case Management Components Assessment Planning Monitoring Coordinating Linking Advocating

14. Assessment Objectives: • Assess Client Engagement and Motivation • Identify Strengths and Supports • Assess Needs • Promote a Shared Understanding of Needs

15. Assessment • Document: • Medical • Psychosocial • Legal • Educational • Financial • Needs of the client

16. Elements of an Interview Rapport create an environment of trust and mutual respect Techniques open-ended questions Reflective listening (paraphrasing) Clarifying questions Case managers personal views and “isms” Assess

17. Comprehensive Service Plan Document; Times and date of service Service needs identified in the current assessment, including the GAIN Assessment of the client and client’s family strengths and needs The plan was developed, to the extent possible, collaboratively with client, family members, and other support and service systems

18. Case Management Monitoring Verify services are being received Assure client adherence to the Plan Assess client’s satisfaction Document progress Celebrate completed goals Recognize client effort/growth Reassess appropriateness of services Update and Revise Service Plan (at least every 90 days)

19. Coordinating, Linking & Advocating

20. Coordination of Community Partnerships • Serve as a Single Point of Contact • Develop Collaborative Networks • Clinical • Courts • Faith-based • Educational • Medical • Probation/Parole • Vocational • Human Services

21. Coordination cont…. • Develop interagency agreements • Establish and maintain credibility • Communicate changes in plan, client status and needs to all team members • Facilitate effective management of client services

22. Linking Services • Link client services to address specific needs and achieve stated goals • Clients are often overwhelmed by the magnitude and complexity of their issues • Link throughout the continuum services • All services and support systems • Provide for needed and timely transitions between levels of care, services and service providers • Link with internal and external systems to provide resources, services and opportunities.

23. Advocating • Advocate for services and actions to meet the clients needs, desires and rights. • Advocate to expand and improve access • Work with community partners to develop new and better resources • Make better use of available community and governmental resources • Assist clients in evidencing need • Empower clients to advocate for themselves

24. CM Lifecycle

25. Case ManagementDocumentation • Client record is a legal document • All entries should be legible, clear, concise and legibly signed by Case Manager • The record should evidence: • An assessment has been completed • CM Plan is in direct correlation with the treatment recommendations

26. Case Management Progress Notes Documentation Elements • Client name • Record number (State Identification Number) • Agency name/Name of case manager • Date/Time/Service location • Documentation of progress, Linkages, client advocacy, and monitoring • Documentation of required face to face contacts and additional contacts made for clients well being

27. Case Management DocumentationElements cont… • CM Authorization voucher • Dated and signed Service Plan • Release of Information (ROI) signed and dated (updated every 90 days) • Informed consent • Documentation of the client’s, family or guardians satisfaction with service (quality measures)

28. Case Management Forms Required Forms: • Supervision Form • Progress Note • PO(Probation Officer) Report(submit weekly for first 6 months, then monthly) • Comprehensive Service Plan • Informed consent • State Substance Abuse Treatment and Recovery Support Services form

29. Case Management Forms, continued RSS evaluation form/voucher request form Forms can be found at: http://www.healthandwelfare.idaho.gov/Medical/SubstanceUseDisorders/RecoverySupportServices/tabid/381/Default.aspx Other forms can be accessed via BPA website or given to you.

31. Billing • Reimbursable services: • Face-to-face contact • Telephone contact • Paperwork completed to obtain service (Client or representative must be present) • Non-Reimbursed Services: • Missed appointments • Attempted contacts • Travel to provide service • Leaving a message • Transporting clients • Documenting services • Group case management • Mental Health services provided by clinical CM

32. Billing cont… • Reimbursement Rates: • Basic/Intensive Case Management- $11.25 pr 15minute unit ($45.00/hr) • Clinical Case Management (Master’s level)- $12.25pr 15 minute unit ($49/hr)

33. Case Management Code of Ethics • Principle 1:  Non-Discrimination • I shall affirm diversity among colleagues or clients regardless of age, gender, sexual orientation, ethnic/racial background, religious/spiritual beliefs, marital status, political beliefs, or mental/physical disability and veteran status. • Principle 2:  Client Welfare • I understand that the ability to do good is based on an underlying concern for the well being of others.  I shall act for the good of others and exercise respect, sensitivity, and insight. I understand that my primary professional responsibility and loyalty is to the welfare of my clients, and I shall work for the client irrespective of who actually pays his/her fees.  • Principle 3:  Client Relationship • I understand and respect the fundamental human right of all individuals to self-determination and to make decisions that they consider in their own best interest.  I shall be open and clear about the nature, extent, probable effectiveness, and cost of those services to allow each individual to make an informed decision of their care.   NAADAC - The Association for Addiction Professionals, Code of Ethics (August 18, 2008)

34. Case Management Code of Ethics Cont… • Principle 4:  Trustworthiness • I understand that effectiveness in my profession is largely based on the ability to be worthy of trust, and I shall work to the best of my ability to act consistently within the bounds of a known moral universe, to faithfully fulfill the terms of both personal and professional commitments, to safeguard fiduciary relationships consistently, and to speak the truth as it is known to me.  • Principle 5: Compliance with Law • I understand that laws and regulations exist for the good ordering of society and for the restraint of harm and evil, and I am aware of those laws and regulations that are relevant both personally and professionally and follow them, while reserving the right to commit civil disobedience. • Principle 6:  Rights and Duties • I understand that personal and professional commitments and relationships create a network of rights and corresponding duties.  I shall work to the best of my ability to safeguard the natural and consensual rights of each individual and fulfill those duties required of me.

35. Case Management Code of Ethics Cont… • Principle 7: Dual Relationships • I understand that I must seek to nurture and support the development of a relationship of equals rather than to take unfair advantage of individuals who are vulnerable and exploitable.  • Principle 8:  Preventing Harm • I understand that every decision and action has ethical implication leading either to benefit or harm, and I shall carefully consider whether any of my decisions or actions has the potential to produce harm of a physical, psychological, financial, legal, or spiritual nature before implementing them. • Principle 9:  Duty of Care • I shall operate under the principle of Duty of Care and shall maintain a working/therapeutic environment in which clients, colleagues, and employees can be safe from the threat of physical, emotional or intellectual harm.

36. Case Management Supervision • Supervision provides a means to: • Protect clients/monitor care • Enhance professional performance • Monitor the readiness of trainees for professional practice • Foster professional development • Impart necessary skills • The ultimate objective of supervision is to deliver to clients the best possible service, in accordance with agency policies and procedures.

37. Documentation of Supervision • Documentation (minimum) • Date and time of supervision • Mode of supervision • Observation • One-on-one • Group • Topics Discussed • Signature and credentials of Supervisor • Signature and credentials of Supervisee (CM) • A minimum of one hour of clinical supervision per month is required

38. Documentation of SupervisionDocumentation (Minimum) • Issues addressed • Progress of supervisee • Signature and credentials of Supervisor • Signature and credentials of Supervisee (CM) • Staff name and credentials • Date of supervision • Mode of supervision • Observation • One-on-one • Group • Duration

39. The End • Questions/Comments • Evaluation • Adjournment Thank you for your participation in today's training!